*Department of Pediatrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; †Department of Auto-immunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark; ‡Department of Orthopaedic Surgery, Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; §Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark; and ‖Department of Gastroenterology, Danish Centre for eHealth & Epidemiology, North Zealand Hospital, University of Copenhagen, Frederikssund, Denmark.
Inflamm Bowel Dis. 2017 Sep;23(9):1473-1482. doi: 10.1097/MIB.0000000000001170.
To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program.
Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4-12 wk after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program.
There were 29 patients with IBD in the eHealth group and 21 patients with IBD in the control group. During the control period, 94 infusions were provided in the eHealth group (mean interval 9.5 wk; SD 2.3) versus 105 infusions in the control group (mean interval 6.9 wk; SD 1.4). Treatment intervals were longer in the eHealth group (P < 0.001). Quality of Life did not change during the study. Appearance of IFX antibodies did not differ between the 2 groups. Eighty percent of patients reported increased disease control and 63% (86% of parents) reported an improved knowledge of the disease.
Self-managed, eHealth-individualized timing of IFX treatments, with treatment intervals of 4 to 12 weeks, was accompanied by no significant development of IFX antibodies. Patients reported better control and improved knowledge of their IBD.
使用患者管理的电子健康计划为炎症性肠病（IBD）患儿和青少年个体化英夫利昔单抗（IFX）治疗时机。
前瞻性纳入接受 IFX 治疗的 IBD 患儿，年龄 10-17 岁。从最后一次输注后 4 周开始，患者每周报告一次症状评分，并提供粪便样本进行粪便钙卫蛋白分析。基于症状评分和粪便钙卫蛋白结果，电子健康计划计算出总炎症负担评分，以确定下一次 IFX 输注的时间（上次输注后 4-12 周）。采用 IMPACT III 评分评估生活质量。纳入对照组比较 IFX 抗体的谷值水平、浓度和治疗间隔。患者及其家长评估电子健康计划。
电子健康组 29 例 IBD 患者，对照组 21 例 IBD 患者。在对照组期间，电子健康组提供了 94 次输注（平均间隔 9.5 周；SD 2.3），对照组提供了 105 次输注（平均间隔 6.9 周；SD 1.4）。电子健康组的治疗间隔更长（P < 0.001）。研究期间生活质量没有变化。两组 IFX 抗体的出现没有差异。80%的患者报告疾病控制得到改善，63%（86%的家长）报告对疾病的认识得到改善。
自我管理的电子健康个体化 IFX 治疗时机，治疗间隔为 4-12 周，不会显著增加 IFX 抗体的产生。患者报告疾病控制更好，对 IBD 的认识提高。
